Vitamin D and Bone Health: A Practical Clinical Guideline for Patient Management

There is growing interest in the importance of vitamin D, not only in the maintenance of bone health but also in terms of its potential role in the prevention of nonskeletal disorders such as auto-immune disease, cancer, mental health problems and cardiovascular disease. Although there is no universal consensus on the criteria for vitamin D deficiency, it is common in the UK, particularly in older people. The awareness that vitamin D deficiency may contribute to the development of osteoporosis and to falls and fractures has resulted in a dramatic increase in requests for serum 25 hydroxyvitamin D (25OHD) measurements. The lack of national guidance on the indications for 25OHD measurements, on the interpretation of the results and on the correction of vitamin D deficiency has resulted in confusion among patients and health-care professionals and in the proliferation of conflicting guidelines and inconsistent practice across the UK. As a result, the National Osteoporosis Society has developed this practical clinical guideline on the management of vitamin D deficiency in adult patients with, or at risk of developing, bone disease. This guideline does not address the management of vitamin D deficiency in childhood, in pregnancy or in patients with severe or end-stage chronic kidney disease (CKD Stages 4–5). The guideline was developed by a group of clinicians and scientists with expertise in vitamin D and osteoporosis. The group used evidence from the Institute of Medicine (IOM) report in 2010, supplemented by literature reviews to identify papers published subsequently. The IOM report itself sought evidence from two systematic reviews from the Agency for Healthcare Research and Quality (AHRQ), based in Tufts University and Ottawa. Where clear-cut evidence was unavailable to inform the National Osteoporosis Society guideline, the authoring group have offered pragmatic advice, based on a consensus of their own views and experience. It is important to highlight that this is a clinical guideline intended to inform patient management but not to influence public health policy. The latter is the remit of the Department of Health Scientific Advisory Committee on Nutrition (SACN), which is currently reviewing the dietary reference values for vitamin D. Funding: The development of this document was funded by the National Osteoporosis Society. We are grateful to the authors for giving their time without charge.